20 Feb 01 - Medicine - Tobacco 'biggest threat to teenagers' health'

A health survey leader says people who sell children tobacco should be included in a proposed register of hard drug dealers.

Dr Martin Plant, director of the Alcohol and Health Research Centre, believes tobacco poses a greater risk to health than drugs and alcohol.

He was speaking at the launch of a European survey indicating 20% of UK children start smoking at 13 or younger.

The UK figures in the survey, which questioned 60,000 teenagers aged 15 and 16, were the worst in Europe.

Dr Plant said: "The Prime Minister suggested we should set up a UK register for people dealing hard drugs.

"I think there are many reasons why that is probably a good idea and I think that register should include any tobacconist who sells tobacco products to 13-year-olds, 14-year-olds or 15-year-olds, because tobacco kills a higher proportion of its regular users than any other drugs."

The survey also showed UK teenagers had the highest level of illicit drugs experience and reported the highest levels of alcohol consumption and intoxication.

Dr Plant said illicit drug-taking currently claimed the lives of 1,200 people in the UK and between 33,000 and 35,000 people died prematurely because of hard drinking, but 120,000 currently died prematurely because of smoking each year.

He called for a crackdown on the sale of alcohol to under-age children in pubs and an end to the illegal practice in bars of serving people who are already drunk.

20 Feb 01 - Medicine - Common cold virus 'linked to cancer'

Scientists have identified a connection between the common cold virus and viruses that trigger cancer.

Researchers at St Andrews University in Fife are hoping to use the similarities between the two to find new ways of treating cancer.

The Cancer Research Campaign Scotland estimates that one sixth of all cancers are caused by infection with a virus, including cervical cancer and some kinds of leukaemia, although until now the reason for this has been a mystery.

Professor Ron Hay, who heads the research team, said: "We are using a cold virus to try to crack the problem because although it does not cause cancer itself, it has features in common with viruses that do.

"Our new research should tell us about the mechanisms viruses use to trigger cancer, perhaps helping in the design of life-saving new drugs."

The research will receive 250,000 from the Cancer Research Campaign over the next three years.

Professor Gordon McVie, the director general of the Cancer Research Campaign, welcomed the development.

He said: "Prof Hay's research is important because if we can find out how viruses cause cancer, we could develop new ways of preventing or treating the disease.

"It would be particularly satisfying if a common cold virus, which has been a nuisance to us for centuries, could one day help to save lives."

Cancer occurs when cells divide out of control, and when viruses infect cells they sometimes remove the brakes that prevent this happening.

20 Feb 01 - Medicine - DNA clues to malaria in ancient Rome

Signs of malaria have been found in the skeleton of a child buried in a Roman cemetery.

British researchers say it is the earliest genetic evidence that the disease plagued the classical civilisations of Rome and Greece.

The child was buried at a site north of Rome more than 1,500 years ago.

Analysis of DNA extracted from the infant's bones reveals signs of infection with the parasite that causes human malaria.

The DNA evidence provides support for the theory that a lethal outbreak of malaria in the fifth century AD contributed to the downfall of the Roman Empire.

"We can be fairly sure that the child died of malaria," said Dr Robert Sallares of the University of Manchester Institute of Science and Technology (Umist), UK, who led the research.

"Ancient DNA research is a new way of investigating the history of disease," he told BBC News Online.

"If we can do the same sort of work on material from older sites, we can determine when malaria entered Europe."

Argument

Terry Brown, head of the department of Biomolecular Sciences, where the study was carried out, said archaeological and ancient historians have argued for some time about whether malaria was a significant factor in the classical civilisations of Rome and Greece.

"We know that communities in Greece and Rome suddenly died out. There's argument over whether some of these communities were wiped out by malaria," he told BBC News Online.

Genetic analysis has documented cases of malaria in medieval times, said Professor Brown. But the study, due to be published in the journal Ancient Biomolecules, is believed to be the first DNA evidence for malaria as far back in history as late Roman times.

Roman fever

The name malaria is derived from the Italian, (mal-aria) or "bad air". It was also known as Roman fever.

It is a very old disease - indeed, prehistoric man is thought to have suffered from malaria.

Each year, 300-500 million people become ill with malaria and several million die , mainly in Africa, India, South East Asia and South America.

20 Feb 01 - Medicine - Stem cells may repair brain injuries damage

Umbilical cord blood injected into the veins within 24 hours could restore the damaged brains of stroke victims. The discovery - so far demonstrated only in laboratory rats - could lead to tests in humans within two years.

The technique might one day also help sufferers from spinal injuries, Parkinson's , Huntington's , motor neurone disease and other brain injuries .

It could also re-awaken the controversy over the use of embryo stem cells as a treatment for disease. Embryo stem cells can change into any of the 300 types of tissue in a human being. Britain last month led the world when parliament changed the rules and permitted the use of embryo cells for research into disease as well as fertility, in the hope that this would open up a new kind of transplant treatment.

Opponents argued that adult stem cells and umbilical cord blood could be altered to provide transplant tissue without raising any kind of ethical problems. There are also other difficulties: one of them is a shortage of donated embryos.

Paul Sandberg, of the University of South Florida, told the American Association for the Advancement of Science meeting in San Francisco that more than 4m children were born in the US each year, bringing with them the bonus of umbilical cord blood. There were also 700,000 strokes a year. Stem cells from cord blood had been used in the treatment of children's blood diseases such as leukaemia. This suggested that the cord blood stem cells could change into something else.

But it was the first hint that they could also change into the neurons and glial cells that make up the brain. Working with a commercial company that preserves cord blood from hospitals, Dr Sandberg's group separated the stem cells and treated them to trigger changes in the precursors of nerve cells. They injected the cells into the veins of rats that had suffered induced strokes. The earlier the injection, the faster they seemed to recover.

When the scientists examined the rats they found that although the stem cells were to be found in many parts of the body, significantly more had migrated to the damaged areas of the brain. The new cells did more than replace damaged tissue, they seemed to stimulate a repair process.

"The animals that had the umbilical cord blood cells showed recovery fairly close to normal levels. The animals that didn't, did not show that kind of recovery," he said. "Most of our studies have involved directly injecting into the brain around the stroke. This is the first time our group is reporting doing an intravenous approach."

Dr Sandberg has already worked with bone marrow stem cells for brain repair, and Sertoli cells, taken from testicles, to trigger new growth in damaged or failing brains. Umbilical cord cells are already being stored at birth to help children in treatment for certain cancers. As the cord stem cells are very young, he said, rejection might be less likely and it might be possible to use cells from one individual to help another.

Because these stem cells are already used in medical treatments, researchers could progress to clinical trials with humans within two years.

"This finding suggests that umbilical cord blood is a noncontroversial, readily available source of stem cells and could provide an alternative to embryonic cells," he said.

19 Feb 01 - Medicine - Anti-wrinkle drug saves face

The elixir that preserves the youthful looks of ageing Hollywood stars has found a new use: as an antiperspirant.

Doctors say that injections of Botox - botulinum toxin A, made from the deadly nerve toxin responsible for botulism food poisoning and used to iron out wrinkles - into the armpits can stop sweating for up to a year.

It is of real value to people who sweat so much that their social life is ruined, but is also being used by models and celebrities in the US to protect expensive couture garments, and by would-be politicians who fear that a sweaty handshake will turn voters off.

Now a study in the New England Journal of Medicine, a respected medical journal, has put the antiperspirant qualities of botulinum toxin A on a solid footing.

A team of German doctors from Munich reported on a multicentre trial of 145 patients with axillary hyperhidrosis - excessive sweating under the armpits. Each patient had one armpit injected with the toxin, the other with a harmless placebo.

The effects were dramatic. Two weeks later, the toxin-treated armpits were producing only about a quarter as much sweat as the placebo-treated ones. The effect had begun to wear off after six months, but was still less than half the initial rate.

The authors, led by Dr Marc Heckmann of the Dermatology Department at Ludwig-Maximilians University in Munich, found no side-effects of the treatment. They conclude: "Injection of botulinum toxin A is an effective and safe therapy for severe axillary hyperhidrosis."

One Birmingham GP who uses Botox, David Eccleston, is very enthusiastic about it. He has treated about two dozen patients. "I think it's the most exciting treatment for years," he said. "It isn't cheap, at £400 a treatment, but it is the safest drug I think I have ever used."

19 Feb 01 - Medicine - Worries over anti-smoking drug dismissed

The government last night sought to reassure users of the new anti-smoking drug Zyban after it emerged that 18 Britons had died after taking it.

The deaths, among more than 270,000 people prescribed the drug, have all occurred over the eight months since the nicotine addiction treatment was launched in June last year.

The Department of Health is also believed to have received notice from GPs of 3,450 other patients suffering possible side-effects, including insomnia, chest pains, dry mouth, rashes, nausea and depression.

Officials said there would be continued close monitoring of Zyban's safety record, as already required through the reporting of suspected adverse reactions to new treatments, but gave no indication that extra measures were needed.

The manufacturers, GlaxoSmithKline, also insisted there was no indication the drug was unsafe and it could play a big part in reducing the 120,000-a-year death rates from smoking-related diseases in Britain.

Zyban seeks to regulate chemicals in the brain thought to be linked to nicotine addiction and its makers last night said that its main ingredient bupropion) was used in 5m anti-smoking treatments worldwide. It was also used in a different formula by 10m people, though not in Britain, as an antidepressant.

Advice by the government's medical controls agency (MCA) to doctors warns them not to prescribe it to patients with a record of seizures or epileptic fits, where there is thought to be a risk affecting one in every 1,000 patients.

It says the contribution of Zyban to any deaths is unproven and suspected reactions "are not necessarily caused by the drug and may relate to other factors such as nicotine withdrawal, other illnesses or other medicines taken concurrently".

The health department added yesterday: "It should be noted that patients may be required to stop smoking because of underlying diseases and these may well explain some of the reported deaths of patients taking Zyban."

Any widely prescribed drug would have a high number of reports from GPs about suspect reactions.

The Mail on Sunday yesterday reported that among the 18 who had died, four had heart attacks, two committed suicide, four died from brain disorders and one had acute asthma. A coroner in Sunderland last week referred to the MCA the case of Alan Ridley, a 46-year-old father of four, who died two days after starting a course of Zyban. An open verdict was recorded at the inquest.

GlaxoSmithKline said: "Zyban is generally well tolerated... and there is no evidence of increased risk associated with the use of this medicine." The reports by GPs had raised no additional safety issues.

Manchester GP Chris Steele, who has prescribed the drug for 400 patients, said the 270,000 patients who had used Zyban by the end of December may now have risen to nearly a third of a million.

"These are people at high risk of serious events like heart attacks or strokes happening anyway because of smoking. Zyban is not a miracle cure but one in three users will stop smoking and still not be smoking in a year. That is twice as effective as a nicotine patch."

Patients on Zyban are usually prescribed one tablet for the first few days of their course and then go on to two tablets, but periods of treatment should not last more than nine weeks.

Dr Steele said: "If a patient is disturbed by any side-effects, I have reduced them from two tablets a day to one a day, and they have continued their course of medication."

19 Feb 01 - Medicine - US Adult Tetanus Shots Being Rationed

WASHINGTON (AP) - Hospitals nationwide are rationing adult tetanus shots, reserving them for burn victims and other severely injured patients, because of a huge shortage of the crucial vaccine.

It's one of the worst drug shortages facing hospitals in years - and don't expect it to be the last. Shortages of medications that hospitals use every day are occurring with more frequency, and worse, they more often involve products with few good alternatives.

While experts can't point to a shortage that has cost a life, it's a possibility that haunts doctors and pharmacists struggling to cope.

``It's really hard to talk about rationing care,'' said Linda Tyler, pharmacy manager at the University of Utah Hospital. The hospital hasn't offered adult tetanus booster shots since fall, reserving scarce doses for high-risk patients with burns, infected wounds or other severe trauma.

``We use it 'til it's gone, and when it's gone, it's gone,'' she said.

So far the tetanus crisis concerns only adult versions of tetanus vaccine, not children's vaccine. But Centers for Disease Control and Prevention experts are watching closely to see if the shortage spreads - and worrying about adult illnesses this spring, when vaccine demand rises along with a seasonal jump in injuries.

Supplies already were tight because of production difficulties when Wyeth-Ayerst Laboratories last month stunned hospitals by suddenly ceasing to make the vaccine altogether, calling it ``a business decision.''

CDC praises the sole remaining manufacturer - Aventis Pasteur - for working around the clock to brew more of the millions of doses needed annually. But each batch takes 11 months to make, so relief isn't expected before year's end.

It's not the only shortage. Abbott Laboratories has run out of lifesaving intravenous Isuprel, kept on hospital ``crash carts'' to revive cardiac arrest victims, because of a problem with its ingredient supplier. Doctors are using workable but somewhat less desirable alternatives.

Eye surgeons are stretching final supplies of Wydase, important in numbing eyes for cataract and other surgeries after Wyeth abruptly quit making it, too.

Also in short supply is the powerful painkiller fentanyl, and Narcan, used to reverse morphine overdoses.

``We call and beg and plead'' for doses, said Carla Gill, associate director of the Johns Hopkins Hospital pharmacy. ``We get dribs and drabs of what we've ordered,'' and pharmacists then furiously work to stretch supplies and find alternatives.

Nobody keeps good statistics, but the nation's largest hospitals and the Food and Drug Administration agree shortages - lasting from weeks to months at a time - are increasing from a few critical drugs a year to about a dozen.

Sometimes FDA discovers health-threatening violations in a factory and temporarily halts production - partly to blame for last fall's flu vaccine shortage.

Some manufacturers decide a product is not profitable enough. With increasing drug company mergers, there are fewer competitors making the same medicines anymore and thus fewer that can quickly pick up the slack.

Companies are notoriously tightlipped in explaining shortages. Take Wyeth, which cites only ``manufacturing-related issues'' in killing Wydase, made in a factory FDA had cited for repeated violations.

Shortages encourage price-gouging, sometimes doubling, says Hopkins' Gill who, a day after the Wydase announcement got a call from a distributor with a stockpile looking to make a deal.

Hospitals are feeling shortages sooner than ever before because, faced with steep medication costs, most now keep only a few days' supply in inventory.

The FDA and CDC are studying which critical drugs are most at risk for shortages, and FDA officials are trying to ease the situation by finding overseas ingredient suppliers or encouraging small drug companies to make a larger competitor's castoff.

But to help hospitals cope fast, Utah's Tyler is working with the American Society of Health System Pharmacists to issue Internet bulletins warning of impending shortages and listing any alternatives.

What's next? Tyler is warily watching whether a medicine crucial for heart surgery that's now on backorder will turn into a real shortage. ``It's put us in a panic.... If we're unable to get protamine, we'll have to think about canceling surgeries that aren't emergencies,'' she said.

``This is a tremendous headache,'' she added, and it's only going to get worse.

19 Feb 01 - Medicine - Aids vaccine gives Africa ray of hope

An Anglo-Kenyan team will begin trials in Nairobi this week of the first Aids vaccine specifically designed for Africa, where 90 per cent of Aids victims live.

The radical new vaccine is the result of a partnership between scientists from the universities of Oxford and Nairobi, which nearly came unstuck over a patent war last year. Parallel trials have already begun on 18 volunteers in Britain to see if the vaccine has any toxic effects.

The vaccine stems from the discovery that 60 prostitutes in Nairobi's Majengo slum - around 5 per cent of the total - were immune to HIV despite massive exposure to it. The women had between five and 10 sexual partners every day, and rarely used condoms. Up to 25 per cent of Kenyans are estimated to be HIV positive, and in Nairobi's slums even more.

'They didn't have the virus or the antibodies. So they must have been getting rid of the virus so quickly that it couldn't get established,' said Dr Job Bwayo, leader of the Kenyan team, yesterday.

Nairobi scientists discovered the women's immune systems were utilising an aggressive cell against the virus. The instant other cells became infected these 'killer T-cells' destroyed them.

'We took the HIV virus and white blood cells from the prostitutes, put them in a test-tube and - bang! - they reacted. The cells killed the virus,' said Bwayo.

The discovery spawned similar studies around the world. A team from Oxford's Institute of Molecular Medicine found the same phenomenon in prostitutes in the Gambia. In 1995 the Oxford and Nairobi teams joined forces. Backed by the New York-based International Aids Vaccine Initiative, their efforts have so far cost $4.5 million - a comparative snip.

The idea of a vaccine is to train the body's immune system to recognise characteristics of an enemy virus in advance, so that it will tell foe from friend when the attack comes. Traditionally, that has meant injecting people with a weakened or killed version of the virus itself, triggering antibodies.

Around 25 experimental Aids vaccines based on this principle are on trial globally. All except one have failed to get past the preliminary test stage. The new vaccine aims to trigger a different kind of immuno-response, producing not antibodies but cells - killer T-cells. Results in animals have been encouraging. Around 30 per cent of monkeys injected with the vaccine proved immune to extremely high doses of Simian Immunodeficiency Virus, HIV's close cousin.

Professor Andrew Mc-Michael, leader of the Oxford team, said yesterday: 'I believe we have a really good chance of this thing working; somewhere in the region of 70 per cent.'

McMichael confirmed that the trialists in Britain, himself included, had suffered no side-effects. 'We didn't expect any and we're very happy,' he said.

If the Kenyan trials go as well , the vaccine will be tried on a large, high-risk population in 18 months. Kenya will be the perfect testing ground because the vaccine is designed for subtype A of the virus, the predominant strain in East Africa. All existing vaccines target subtype B, predominating in Europe, Asia and America. 'As a vaccine for people in the UK this would not be optimal, though we believe we could adapt it quite easily,' said McMichael.

The best case scenario would see manufacturers called in after two years of population trials, and the vaccine widely available in another two years: around six years from now. Bwayo said: 'This vaccine may not prove to be the one. But we have hopes that, if not, one of the modifications currently being produced in Oxford will be.'

Three months ago, such co-operation briefly seemed a distant dream. Reports that McMichael and a colleague, Dr Thomas Hanke, had patented the vaccine without mention of their Kenya colleagues caused a storm in the region's media. McMichael and his colleagues flew to Nairobi for emergency talks, and the two teams agreed to leave all patent matters to an independent panel of experts.

19 Feb 01 - Medicine - Alien cells may cause arthritis in women

Women could be 10 times more likely than men to suffer from rheumatoid arthritis, lupus, multiple sclerosis and other autoimmune diseases because they carry alien tissues in their bloodstreams - cells from their children and mothers.

Lee Nelson of the University of Washington told the American Association for the Advancement of Science in San Francisco that even 30 years after the birth of a son, male foetal cells could be detected in a woman's blood stream at levels of one in a million.

The presence of these alien cells could indirectly affect the mother's immune system. Immune systems work by detecting and attacking invading cells - bacteria, viruses and so on. Sometimes, immune systems attack their own host, to cause scleroderma, multiple sclerosis and up to 100 other diseases. Autoimmune diseases are among the top 10 killers of women under the age of 65.

"Traditionally, autoimmune diseases are described as your cells attacking your own healthy tissue," she said. "Our findings raise the question as to whether some autoimmune diseases are not entirely autoimmune, whether they actually have a component that is non-self. It's really an entirely new paradigm."

Her research began with rheumatoid arthritis, which goes into remission when women are pregnant but returns after delivery. Immunologists have been interested for decades in why babies aren't rejected after conception, in the way that transplanted organs are rejected by the immune system. But the invasion by a "stranger" turned out to last far longer than nine months.

"In women who have had, for example, a son, you can look 10, 20 or 30 years later at a drop of blood, and find a male cell in there. Similarly you would find cells from a daughter. It's just a little easier to track a male cell in a woman," Dr Nelson said. "The basic theme is that pregnancy is an immunologic event, it is not just a change in hormones, it's actually exposure to a being who is half yours, because half the genes come from the father."

Some of the mother's cells went into the child as well. There were other ways of acquiring a "stranger" within - from a blood transfusion, from a twin, and even from a twin you never knew you had, because many pregnancies began as twins, with one of them lost at a very early stage.

"Probably those cells have a beneficial, neutral or detrimental function depending on what particular relationships there are of the genes that help you determine what is self, what is other," said Dr Nelson. It could explain why women had more autoimmune disease than men, because there were more chances of carrying alien immune system cells.

These were a set of genes on the sixth chromosome, essential to distinguishing self and non-self, called the human leukocyte antigens, or HLA genes. Knowledge of how these genes work could help scientists think of widely different illnesses as stemming from one source. It could also explain why some diseases retreated during pregnancy, and then became better or worse afterwards. It might also explain why one twin might have the disease, but another did not. One child would develop multiple sclerosis, but his or her identical twin had only one chance in 20 of developing the same disease

"It's a fascinating area and it will give us, hopefully, a whole new way of treating these diseases because we can target those cells," she said.

One of the first targets for new kinds of treatment could be scleroderma, which affects about 14 in a million worldwide - mostly mothers. It causes hardening of the skin on the hands and face, and pain in the joints. In some forms it hardens internal tissue, causing organ failure and death.

19 Feb 01 - Medicine - The deadly cost of economy class

Deep vein thrombosis is thought to kill 2,000 British aeroplane passengers each year. Now major airlines are facing accusations of negligence for not telling us about the risks

Heightened concern about thrombosis risks on flights, following the death last October of 28-year-old Emma Christofferson after a Qantas flight from Australia to London, has prompted a rush of prospective claims of negligence against airlines.

Ms Christofferson, a fit and active non-smoker, collapsed in the arrivals hall at Heathrow and died before reaching hospital. She had been suffering from deep vein thrombosis (DVT), a condition now commonly referred to as "economy-class syndrome", because of its reputation for affecting passengers sitting in cramped airline seats.

DVT involves the formation of a blood clot in the leg. It can sometimes occur on long flights where passengers are immobile and often slightly dehydrated from breathing dry re-circulated air - factors which can encourage DVT to develop. DVT can be dangerous and will often require hospital treatment. Worse, though, is the onset of pulmonary embolism, where the clot moves to the lung. This can happen when the person starts moving again after a period of inactivity. It can be instantly fatal.

In Australia, lawyers at Slater and Gordon are currently working on 2,500 potential cases against a number of airlines. Passengers stricken with DVT, and relatives of those who had died after flights, contacted the firm when media coverage of the condition intensified towards the end of last year.

Brendan Sydes, a partner at the firm, said that the cases are currently at the enquiry stage and that the firm is examining the best legal strategy to follow.

"There has been no formal contact with the airlines yet, so we have not had a reaction, but they seem to be keeping a low profile," says Mr Sydes. "With such a large number of cases, it involves a wide range of international airlines, including companies such as Qantas and British Airways."

In the UK, law firms are at a similar stage in the preparation of cases, with enquiries increasing rapidly over recent months.

Gerda Goldinger at Collins in Watford, a law firm with particular expertise in personal injury and transport litigation, says that they have a large number of clients who have developed DVT on flights and are now planning legal action.

"Quite a few are young, fit people in their twenties, with no previous health problems and no known predisposition to DVT," she says. "Some were struck as they were disembarking from the plane, whilst others suffered symptoms a week to ten days later. In some instances they died, in which case we are acting for the relatives."

Like Slater and Gordon, Collins is investigating a range of ways of proceeding, but will be sending out letters of claim in the near future.

"We do not have to prove 100 per cent that the flight caused the DVT," says Ms Goldinger. "It is done on balance of probability, which means that experts such as vascular surgeons may be used as expert witnesses. Claims for injury will vary according to the exact circumstances, but could easily be £10-15,000 or higher. Where the death of someone with dependants has occurred, compensation could be in the region of £500,000 or more."

Club Direct, one of the UK's leading travel insurance companies, announced this month that it will pay the legal costs of policyholders who have a case to sue negligent airlines, tour operators or travel agents. It is a move intended to move the travel industry quickly towards providing better health information to customers, an act which will both save lives and reduce the risk of the travel provider being found negligent. Travel insurance policies do not normally cover this risk, and those purchased from travel agents usually expressly exclude claims against airlines and travel suppliers.

"We will provide up to £25,000 of legal costs for taking action against negligent providers," says Brent Escott, managing director of Club Direct. "That is in addition to £10 million of cover for medical costs incurred abroad as a result of DVT."

The company is also making information on risk factors, warning signs and measures to reduce the likelihood of death or injury due to DVT available to the general public.

A programme has also been launched to speed up medical research, including an appeal for research funds. Information is being channelled through MediQuote, the travel-related medical assessment organisation.

"Nobody has died from the crashing of a British commercial plane in the last 10 years, but deaths in this country from DVT caused by flights are thought to be in the region of 2,000 a year," says Brent Escott. "Airlines should keep this in mind when warning passengers about life jackets and brace positions. A little advice about how to avoid getting DVT would save substantially more lives. Both airlines and travel suppliers need to take greater responsibility for warning passengers of the risks, if they want to avoid legal action."

Farrol Kahn at the Aviation Health Institute says that UK death figures could be even higher than 2,000. "Some people die a few weeks after they get off the flight, but there is no research at that stage that links the death back to the flight. Around 6 per cent of the British population is in a high-risk group for DVT, due to genetic factors. On each jumbo jet, around 15 passengers will be in this group, and many more will be also be at high risk due to age, being on the Pill, having a minor leg injury, or being pregnant. However, you don't need to be in a high risk group to get the condition; it can happen to anyone."

Compensation claims need not necessarily be directed at the airlines. Travel agents and tour operators could be in the firing line too.

"The Warsaw Convention places limits on the size of claims against airlines, and there is a two-year period within which the claim must be made," says Ms Goldinger at Collins. "However, the claim need not necessarily be made under the terms of the convention, and travel agents and tour operators are not covered by it in any case."

One of the keys to proving a negligence claim must be that the supplier knew about the risks but did not take steps to warn passengers. It is thought that some airlines may have been warning employees about circulation and DVT risks for some time, but had not instructed them to pass on this advice to passengers. If this is the case, and employees come forward who can confirm the story, it could pose a severe problem for the airlines concerned.

Airline staff and medical representatives met in Sydney earlier this month to discuss action on DVT flight risks. Two further meetings are planned in Geneva in March and May. A number of airlines are now stepping up their procedures for informing passengers on ways of reducing the risk of developing DVT, but, as yet, there is no standard procedure that applies to the industry as a whole.

British Airways has had one claim enquiry so far, but is not willing to discuss the matter. JMC Airlines has also issued a statement on DVT claims, confirming that it has "...received correspondence from solicitors representing a passenger who travelled to the Caribbean last December". The company is investigating the allegations, but will not comment further at present. However, most cases are still in the preparatory stages and many more can be expected to emerge over the coming months.

Companies such as British Airways, Qantas and JMC are all now taking action to inform passengers of DVT risks, ranging from leaflets with tickets, to in-flight briefings, exercise programmes and magazine articles. However, many airline passengers are still unaware of where they stand in the level of risk or what they should do to reduce risk on the flight.

"The burden of proof on DVT risk varies between what a doctor, a lawyer and an insurance underwriter will require," says Club Direct's Brent Escott.

"Doctors need to show research that links the death or injury back to the flight, and which shows ways in which the risk can be reduced. Lawyers need to show a balance of probability that the flight was the cause of DVT, and that the airline or agent was aware of the risk but did notwarn the customer. Insurance underwriters have to demonstrate the likelihood of a risk taking place and quantify the level of risk. As an insurance supplier, we know the risk is there, because some of our customers have died from it. It could be another year before medical research is completed on the subject, by which time another 2,000 people will have died. We want to see action taken now, so that all airline passengers are made aware of the risks and how to reduce them."

More legal cases can be expected over the coming months. Airlines and doctors are striving to come up with a way of providing advice that will help to save the lives of passengers. In the meantime, airlines and travel providers which do not provide adequate information to customers lay themselves open to the risk of negligence claims.

Scientists believe they may have found the underlying cause of the mysterious "auto immune" diseases including multiple sclerosis, rheumatoid arthritis and type-1 diabetes.

Microscopic quantities of blood passed between mothers and their babies during pregnancy have been linked with triggering an aberrant attack by the body's immune defences on its own tissues and cells, causing the autoimmune reaction.

Researchers have detected genetic material derived from the blood of a mother's son in her own bloodstream up to 20 years after she gave birth. They believe this transfer of material in the womb could account for why women are 10 times more likely to develop autoimmune diseases than men.

The findings, presented at the annual meeting of the American Association for the Advancement of Science in San Francisco, could lead to new treatments for many of these conditions. The findings could also explain autoimmune diseases in men and in women who have never had children. They have been found to carry cells that have passed into their bloodstream from their mothers during pregnancy.

Scientists believe the presence of what is in effect "foreign" material circulating for years in the bloodstream could be the initial trigger that subverts the immune system into attacking different parts of its own body where these alien cells have grafted on.

Professor Lee Nelson, who led the research, said: "Traditionally, the autoimmune diseases are described as your cells attacking your own normal, healthy tissue. Our findings raise the question as to whether some autoimmune diseases actually have a component that is non-self."

Autoimmune diseases are among the top ten killers in the developed world.

19 Feb 01 - Medicine - 18 anti-smoking drug patients die

Doctors monitoring the safety of Zyban, an anti-smoking drug, have reported the deaths of 18 patients who had been prescribed the medicine.

Since it became available on a prescription basis last June, 270,000 smokers in Britain have been given courses of the drug, which works by inhibiting the craving for cigarettes. The Medicines Control Agency, which is conducting an intensive monitoring programme on Zyban, has received reports of 3,457 patients complaining of adverse reactions.

The large majority of incidents have involved mild side effects such as insomnia, rashes and dryness of the mouth but there have been 73 reports of people suffering seizures. One of those was a Manchester ambulance driver who crashed when responding to an emergency call.

The patients who died, one of whom was just 21, were taking the drug but there is no medical evidence that Zyban contributed to their deaths. As smokers, they were all members of a high-risk group. One man who died had not informed his doctor of a family history of blackouts and fits when he was prescribed the drug to tackle a 40-a-day habit.

A Department of Health spokesman said: "We have asked GPs to report all suspected adverse reactions. The drug has been widely prescribed so we were expecting a large number of reports."

GlaxoSmithKline, the manufacturer of the drug, said it took reports of adverse reactions to the drug very seriously but said there was no evidence that it was dangerous. A spokesman said: "More than 15 million people worldwide have taken bupropion hydrochloride, the active ingredient in Zyban and there have been extensive clinical trials. All medicines have adverse events and there is nothing to suggest there is a cause for concern."

Dr Alex Bobak, a London GP, said the level of side effects reported was high but that was because doctors had been told to monitor the new drug closely.

Britain could become a haven for malaria-carrying mosquitoes and some water supplies may become tainted by sea water, a United Nations report on global climate change will warn tomorrow.

The 1,000-page draft volume entitled Climate Change 2001: Impacts, Adaptation and Vulnerability will be adopted in Geneva by government delegates from more than 100 countries.

The assessment details the possible effects of a predicted rise of average global temperature of between 1.4C and 5.8C over the next 100 years. The proliferation of organisms such as ticks, mosquitoes and sandflies is likely to increase the risk of transmission for tropical diseases such as malaria and dengue fever.

Malaria existed in Britain in the 16th and 17th centuries, but better housing and the draining of marshland eradicated the disease.

The UN report also predicts that parts of Britain's coastline could be submerged by 2100 and water supplies tainted as sea levels rise due to temperature increases melting the polar ice caps.

The panel's study of the impact of such a change on Europe will say that without a costly upgrading of coastal defences, some wetlands and lowlands could disappear and shorelines could be eroded. If the predictions come true, coastal flooding from storms would become worse and river estuaries and underground aquifers would become tainted with salt water.

The report will also say that it is "very likely" that climate change will alter the hydrological cycle, meaning it will "rain harder and evaporate faster".

As well as an increase in public health problems, the report also predicts that agriculture and infrastructure costs will be affected by climate changes.

Rice production in America and southeast Asia, where it is the staple food, is singled out as a crop likely to be adversely affected by global warming.

However, risks of frost would be reduced in a warmer climate and potential yields of winter crops are expected to increase, especially in central and southern Europe and western Russia.

Michael Williams, of the United Nations Environment Programme, said climate change could not be stopped but it could be minimised by reducing greenhouse gases and the use of aerosols.

"The developed countries emit most of these warming gases but the bulk of the problem will be felt in the Third World where droughts and floods will become even more devastating." said Williams.

Britain is the only European Union country where flood insurance can be bought on the free market. Elsewhere in Europe, countries either have government-backed insurance or none at all.

The report will say that an increased number of summer droughts would also heighten fire danger, especially in the popular holiday destinations of the Mediterranean.

UN experts predict that insurance prices are likely to go up because of the increased probability of rivers flooding in northern Europe.

The most dramatic potential effect of climate change, the collapse of the western Antarctic ice sheet which could lead to a catastrophic rise in sea level, is now considered unlikely in the next 100 years.

Earlier this month the Department of Health warned that malaria could return to England's southern counties within 20 years.

19 Feb 01 - Medicine - Cult scientists prepare to clone human baby

Work begins next month on creating the world's first cloned baby. It is intended to be given to a couple who want to recreate their 10-month-old son who died in a hospital operation.

The controversial process is being undertaken in America by a secretive commercial organisation called Clonaid, registered in the Bahamas.

A geneticist, a biochemist and an in-vitro fertilisation expert have been commissioned to produce a genetic copy of the dead baby.

The unnamed couple, described as deadly serious about their ambition, have paid £300,000 to fund the work.

Clonaid has recruited 20 egg donors and 50 volunteer surrogate mothers to carry the pregnancy. The clone will be created by inserting the nuclei of cells from the dead baby into cell "envelopes" from the egg donors.

The project leader is Brigitte Boisselier, a French-born biochemist and scientific director of Clonaid. She has two doctorates and teaches chemistry at Hamilton College in New York state. She said the attempts at successful implantation will begin shortly, with the intention that the first cloned baby should be born by the end of the year. "For us the purpose of this project is philosophical: to create eternal life," she said.

Clonaid is owned by the wealthy Raelian movement, a religious cult which believes that all humans are cloned from a group of alien scientists from another planet.

A South Korean team already claims to have created a human cloned embryo, but nobody has attempted to implant it in a woman. Animal cloning has produced huge numbers of foetuses and offspring with gross abnormalities, and most scientists have shied away from the inevitable condemnation that would follow the creation of a deformed human baby.

Apart from cloning, the main preoccupation of Raelians is the creation of an embassy to welcome aliens arriving on Earth.

Unlike Britain, America has no legal ban on cloning but research has been hampered by a ban on the use of public funds. The country's Food and Drug Administration is monitoring the Raelian initiative.

Although some experts doubt whether the Raelians have the expertise to achieve success, others say it is simply a question of mathematical probability: 20 egg donors and 50 surrogate mothers would probably be enough.

The Raelians, who have 50,000 members worldwide including a number in Britain, are conducting the project at a secret location in America. Boisselier said 100 people have put their names on the waiting list for treatment, including five British couples, two of whom are homosexual.

Scientists from the Cancer Research Campaign at Manchester's Paterson Institute are now trying to discover the keys to this process.

If senescence can be controlled, it might be possible to put cancer to sleep.

Lead researcher Dr Naoko Ohtani said: "Cancer cells are a bit like rowdy partygoers who stay up all night long while healthy cells know when it's time to go home.

"We are trying to find out what makes healthy cells senesce. If we can find out how the process goes wrong in cancer cells, we may be able to find the chemical equivalent of a lullaby that will send these rowdy cells to sleep for good.

"We know there is a group of molecules that induce senescence and we believe that in the future we may be able to mimic this to produce a completely new cancer treatment."

Professor Gordon McVie, director general of the Cancer Research Campaign, said: "Cancer cells' continual activity - or refusal to go to sleep - is one of the key problems facing cancer doctors today.

"If Dr Ohtani's team can discover how cells fall asleep permanently, it could lead to a brand new way of treating cancer."

Scientists may be on the brink of curing Parkinson's disease using transplanted embryonic stem cells.

Dr Ole Isacson of Harvard Medical School and Dr Ronald McKay of the National Institutes of Health said they have both "cured" Parkinson's in mice and rats.

Dr McKay said the technique may be tested on humans in Britain, France or the Netherlands, as those countries are adopting policies to advance embryonic stem cell research.

In a report at the national meeting of the American Association for the Advancement of Science, Dr Isacson said mouse and rat embryonic cells can be grafted into the animal brains where they transform into replacements for cells killed by Parkinson's.

Using a slightly different technique, Dr McKay said his NIH lab has also prompted mouse embryonic stem cells to convert into cells that are lacking in Parkinson's.

In the United States, some groups oppose the use of embryonic stem cells in research because gathering the cells requires the death of a human embryo.

Parkinson's is a disease caused by the death of brain cells that produce dopamine, a key nerve chemical. When patients lose about 80% of these cells, they develop the classic Parkinson's symptoms: tremors and rigidity.

Parkinson's can be treated with L-dopa, a drug that makes dopamine in the brain. But L-dopa is effective for only a short time and after that the disease progresses.

The best hope for a cure, said researchers, are the embryonic stem cells. These are master cells that can be coaxed to transform into virtually any type of tissue in the body. Embryonic stem cells can be grown in great numbers, making them readily available for treating thousands of patients, the researchers said.

Scientists say a genetically modified cold sore virus could one day be used to fight skin cancer.

In a preliminary patient trial, scientists have shown that the virus kills malignant and spreading tumour cells.

It targets skin tumours selectively, confining itself to areas affected by the cancer, and appears to be non-toxic.

The trial, reported in the Lancet medical journal, was a pilot study on just five patients to test whether the virus treatment was safe.

Nonetheless the results indicate that the herpes simplex virus (HSV) - which causes cold sores - could prove a powerful weapon against melanoma, or skin cancer.

It will be at least 10 years, however, before such a treatment is fully developed.

Professor Rona MacKie, who led the study at the University of Glasgow, commented: "At the moment, other than surgery, we have nothing that works against late-stage melanoma.

"I would hope that herpes simplex might be included in non-surgical therapy for this disease in the future. We cannot yet say that it will be, because a lot more work has to be done first."

HSV is a virus that is naturally attracted to nerve tissue. The cells that give rise to melanoma are derived from the developing nervous system in the foetus, which is thought to be why HSV targets skin tumours.

It also likes to attack actively dividing cells, which is another reason for its affinity with cancer.

19 Feb 01 - Medicine - Sickly babies less likely to develop asthma

Sickly babies are less at risk of developing asthma than healthy youngsters who are never ill.

German scientists believe that viral infections in early life may stimulate children's immune systems.

One in seven UK children aged two to 15 has asthma, the number of under-fives with the condition has doubled in the past decade.

The scientists say children who suffer from a runny nose more than twice in their first year of life are half as likely to have asthma by the age of seven as babies who only have one or no attacks of the sniffles.

The study, published in the British Medical Journal, adds to the debate over whether our modern, hygienic lifestyles in which children are given many vaccinations and antibiotics, may be contributing to rising rates of asthma.

More than 1,300 children from birth to the age of seven to detect rates of asthma were studied by the research team.

They found that by the age of seven, 6% of children had been diagnosed with asthma and 10% had suffered from wheezing in the previous 12 months.

Youngsters who had developed respiratory tract infections in their first year were more likely to have developed asthma by the age of seven.

But children who had suffered more than two episodes of other viral infections in their first 12 months, such as a runny nose, were 50% less likely to have been diagnosed with asthma.

Report author Sabina Illi, research assistant at the University Children's Hospital in Munich, said: "Our results suggest that repeated viral infections other than lower respiratory tract infections early in life may stimulate the immature immune system... Thereby reducing the risk for the development of asthma up to school age."

19 Feb 01 - Medicine - Cancer breakthrough as tumour is recreated

Researchers are claiming a breakthrough in the fight against cancer after recreating the development of the disease outside the human body.

Scientists working for the Cancer Research Campaign in Wales say they have mimicked the creation of a tumour in the laboratory for the first time.

The team claim that recreating the early stages of tumour growth has already led to a major step forward in understanding how tumours start.

Professor David Wynford-Thomas heads the Cancer Research Campaign Thyroid Tumour Biology Research Group at the University of Wales in Cardiff. His team carried out a breakthrough experiment by adding the mutant RAS gene to healthy human thyroid cells and watched as it caused a tumour to grow.

"Most cancer genetic studies are aimed at cataloguing the genes which are abnormal in a particular type of tumour," he said.

"But they cannot determine which is the key gene responsible for causing the tumour to start growing in the first place. Our work proves that the RAS gene can start the ball rolling by turning on signals which cause inappropriate cell multiplication.

"It is like a jammed accelerator which makes the cell keep on reproducing itself when it should not. Recreating this early phase in tumour growth in the petri dish has given us the means to study how RAS causes this unwanted effect.

"We have already made substantial progress in working out key signals which it turns on in cells."

Details of the team's ground-breaking work are being given at a CRC-backed National Cancer Symposium in Manchester.

Prof Wynford-Thomas says the findings are important because they provide new targets for drugs to aim at in the fight against cancer.

12 Feb 01 - Medicine - 'Give Tamoxifen to women at risk'

The British "wonderdrug" Tamoxifen should be offered to women at risk of breast cancer because of increasing evidence that it can prevent the disease, the World Summit Against Cancer, in Paris, was told. Bernard Fisher, Professor of Surgery at the University of Pittsburgh and a world authority on breast cancer, said lives could be saved if post-menopausal women and those at high risk took it.

12 Feb 01 - Medicine - Why ministers are wrong

It is just over a year since the Prime Minister revealed during a television interview that he intended to raise total healthcare spending to match the average proportion of Gross Domestic Product (GDP) spent in the rest of the European Union.

Most commentators agreed that Tony Blair's calculations were "plain wrong". Moreover, the financial feasibility of setting such a target had not been thought through - nor, indeed, had the sense in setting it in the first place. New data from the Organisation for Economic Co-operation and Development (OECD) makes it clear that UK spending on healthcare will remain significantly below the average of other EU countries over the next few years.

Despite all the evidence to the contrary, the Government still seems convinced that it has done enough to lever UK healthcare spending into the middle of the EU pack. Before Christmas, the Secretary of State for Health, Alan Milburn, returned to the fray. Giving evidence to the House of Commons Health Committee, Mr Milburn claimed it was the experts who were mistaken, and the figure we should be aiming for is 8 per cent of GDP - a target he reckons will be achieved.

However, calculations by the King's Fund and the LSE suggest otherwise. The chart (shown right) - based on the latest OECD health data for 2000 - illustrates the inexorable rising share of national wealth consumed by healthcare in the EU and the UK since the 1960s.

The chart is interesting for a number of reasons. The most obvious is the projected gap between the UK and the rest of the EU in terms of the average proportion of GDP spent on healthcare.

While Mr Blair suggested that New Labour's aspiration was to close this gap, it is evident from projecting the EU average that, despite the extra billions promised in last year's budget, the (moving) target will be missed.

In fact, based on our own calculations, by the end of the next Parliament in 2006, the UK will remain significantly below the average for the rest of the EU, which, at nearly 11 per cent is somewhat higher than the Government's figure of 8 per cent. In fact the rest of the EU is already spending 9 per cent. At this rate the gap between Britain and the rest of the EU will be narrowed only to what it was in 1999. While in the next few years the other countries will spend over one euro in 10 on healthcare, the UK will trail at just 0.7 out of every 10.

The Government has got itself into a muddle over targets for healthcare spending, a confusion it could easily have avoided and which was unnecessary, especially given the scale of additional money for the NHS.

There are, of course, good reasons for governments to set targets: they communicate intent and aspiration to the electorate; they provide a benchmark for measuring improvement; and they can help close the tax-and-spend loop by showing how taxpayers' money is being used.

But there are also dangers with this approach - among them the setting of a target that will not be achieved. If we really want to compare ourselves with our EU neighbours, then a more pertinent comparison should take account of what we as a nation both want and can afford to spend on healthcare.

Although in 1998 the UK economy was the EU's second largest in absolute terms, we are not so rich in terms of GDP per head, ranking 10th out of 15. Given this, and the fact that health spending per head and GDP per head are strongly linked, we calculate that by 2006 the UK should expect to spend around 18 per cent more than we have projected.

Although this is still a substantial gap, it is less than half that arising from comparing ourselves with the EU average - in financial terms, £18bn compared with £37bn in 2006. And as UK wealth per head increases over time, we would expect a greater proportion of it to be devoted to healthcare - as it is in other, richer countries.

Sean Boyle works at the Department of Operational Research at the London School of Economics. John Appleby is Director of the Health Systems Programme at the King's Fund.

11 Feb 01 - Medicine - MMR uptake figures steady

The number of parents taking their children for the controversial MMR jab has stopped falling. Health experts say nearly nine out of 10 UK parents now take their children for the measles, mumps and rubella (MMR) jab.

The latest data from the Public Health Services Laboratory Services (PHLS), shows that the take-up for the jab fell sharply in 1996 after Dr Andrew Wakefield published his first controversial paper linking it to autism and bowel disease.

The rate dropped then from 92.5% to an all-time low of 87.6%.

But current figures show that the vaccination rates have now stabilised at 88%.

A spokesman for the PHLS said they were delighted by the figures and hoped public confidence would continue to grow as more and more data pointed to the safety of the jab.

Stable figures

"There was a fall after the initial criticisms, but for the last two years the vaccine uptake has been basically stable.

"Obviously what we are now hoping is that we will be able to build on that and we are hoping we will get the uptake levels up to 92-95%," he said.

"Almost nine in 10 parents in this country are having their children vaccinated and that is important in bear in mind," he said.

A major study, published in the latest edition of the British Medical Journal by Dr Hershel Jick, of Boston University, shows there appears to be no link between MMR and autism.

This is expected to encourage even more parents to take their children for the jab.

Doctors are also showing more confidence in the drug - linking fewer cases of the drug to autism.

Rise in adverse reactions

The Medicines Control Agency (MCA) monitors all drugs under its yellow card system.

Doctors spotting problems with a particular drug report them to the MCA on a yellow card and the data is held centrally to highlight any problems.

Latest data from the MCA shows that there was just one yellow card report last year of autism following MMR compared to 15 reports in 1997.

There have been no yellow cards over the last three years linking the MMR jab to bowel disease.

But the MCA reports an increase in adverse drug reactions linked to the MMR and a rise in the number of reactions classed as serious.

Publicity influence

Since the jab was introduced in the UK in 1988 there have been 3,453 reports of adverse reaction, including 42 of autism; 17 of autistic behaviour and three of bowel disease.

The Department of Health confirmed the figures, but said it was important to remember that the MCA threshold for "serious" was very low and included fainting and swollen glands as symptoms.

A DoH spokeswoman said: "Adverse drug reactions can include things such as rise in temperature, fainting and swollen glands.

"Rates of reporting have risen, but they are influenced by publicity."

11 Feb 01 - Medicine - Scientists locate chromosomes that can kill

British scientists have identified the "killer chromosomes" thought to carry the highest concentration of genes that cause fatal human diseases.

The scientists, part of the 10-year international Human Genome Project(HGP), found that out of the 23 pairs of human chromosomes, three are the most likely to be associated with genetic disease.

Their work, to be released tomorrow, is predicted to lead to new therapies for many of the diseases associated with the chromosomes, including prostate cancer and Alzheimer's.

The work was carried out at the Sanger Centre, near Cambridge, which in 1999 also achieved the first complete sequencing of an entire chromosome - chromosome 22.

Sir John Sulston, former director of the Sanger Centre, said: "Britain can be proud of the scientists at the Sanger. We believe our efforts, our intellectual gift to the world, are providing a vast array of clues to other researchers as to why these diseases arise, and therefore opening up new ways of diagnosing and treating them."

The full results from the HGP are to be published in Nature magazine. The work of Celera, an American genome-sequencing company set up in rivalry to the HGP, will be published simultaneously in Science. This weekend, Dr Craig Venter, a scientist at Celera, said researchers on both projects had been startled by how few genes they had found in the human genome. The discovery last year of the small number of genes - 26-40,000 as opposed to the expected 100-150,000 - could lead to a radical downgrading of the importance of genes in human development, said Venter. Some biologists claim they pre-programme virtually every human trait from hair colour to sexuality. However, Venter said: "The wonderful diversity of the human species is not hard-wired in our genetic code. Our environments are critical."

In the mid-1980s scientists realised that they had the tools to work out the sequence of the four basic molecules (or bases) in every chromosome.

However, given that the genome has three billion bases in total, it needed a massive international research effort. This led to the birth of the HGP in 1990. The Sanger Centre took responsibility for eight chromosomes and found it had landed responsibility for 39% of the world's genetic diseases. Each chromosome carries thousands of genes that act as blueprints for the manufacture of proteins and so ultimately control everything that goes on in the body.

This means that when genes mutate or are damaged, they also cause illness: heart disease, cancer and Alzheimer's are all known to have strong genetic components.

Genes on chromosome 1 are associated with Alzheimer's disease and prostate cancer. Genes on Chromosome 6 has been linked to intelligence. It is, however, the X chromosome that has proved particularly disease-rich. One segment alone has been implicated in dozens of genetic diseases. Among these are Duchenne muscular dystrophy, which kills children and young adults by preventing their muscles from growing properly.

10 Feb 01 - Medicine - Rubber trees may yield blood protein

Rubber trees in Malaysia may soon flow with albumin, the protein in human blood given in transfusions, with rubber for making aircraft tyres as a useful byproduct.

Hoong-Yeet Yeang, of the Rubber Research Institute in Kuala Lumpur, told the Biovision 2001 conference in Lyon in France, that trees "milked" for nearly a pint of latex sap every other day could be genetically engineered to provide commercial enzymes for shampoos, for chemotherapy drugs, as well as safe human blood products for hospitals.

Working with young trees and low funds, he had done experiments with dozens of plants supplying albumin.

Bananas have been developed to "grow" human vaccines. Strawberry plants have been modified to make anti-decay toothpaste. But albumin is a vital protein needed in huge quantities to drip into the bloodstreams of accident and surgery victims.

Supplies in Britain have been interrupted because of fears of contamination by donors with variant CJD. Other teams have genetically engineered sheep to provide albumin and other blood products.

Rubber was part of the Malaysian landscape, said Dr Yeang. "But in recent years the price of rubber has not been very good. So there is a great incentive to find new uses for the rubber tree and this is an obvious one. You can get continual production just by tapping rubber trees."

In making high quality rubber the important ingredient in the sap was latex, but a high proportion of the sap was protein that had to be removed as waste. Therefore plants could be the ideal factories for blood and other valuable proteins, he said. "Grown in the field, plants require little more than sunlight, water and basic horticultural input to survive. As protein manufacturing factories, plants are solar-powered and ecologically friendly."

Dr Yeang and his colleagues introduced the albumin gene into the tree's DNA sequence, and persuaded it to release the protein to make 70% of the sticky liquid tapped from the tree.

10 Feb 01 - Medicine - Return of malaria feared as climate warms

Malaria could return to southern counties in the next 20 years as the climate warms, and during the summer months half of England would be at risk of an outbreak, the Department of Health said yesterday.

In the department's first review of the effects of climate change on the nation's health, it said that warmer summers would provide a foothold for tropical diseases, and much greater spread of tick borne ailments like Lyme's disease, which attacks the joints.

Higher temperatures would cause 10,000 more cases of food poisoning, add 2,000 to the 800 deaths each year from heatstroke and, combined with the hole in the ozone layer, cause an extra 5,000 skin cancers and 2,000 cataracts a year.

Not all the news was bad. Cold kills more than 80,000 people a year through heart attacks and other circulation problems. Scientists expected this to drop by 15,000 by 2020, and another 5,000 by 2050. The milder winters would also cut the annual steep rise in hospital admissions that so disrupts the NHS each year.

Less certain were the health effects of the heavy rain, flooding and storms that were expected to become a feature of the British climate.

In Scotland, this was expected to lead to increased damp in houses causing winter ailments, and milder winters and more standing water offering breeding grounds for clouds of midges. This would make life unpleasant and damage the tourist industry.

It was the expected early arrival of malaria that most exercised Liam Donaldson, the government's chief medical officer, yesterday.

He said it likely to involve the milder form of the disease, plasmodium vivax, which did not often kill but frequently recurred.

More than 2,000 cases of traveller's malaria were reported each year, and more than two-thirds of these were life threatening.

The vast majority of victims had been on holiday abroad, but there had been about 60 cases recorded of people living near airports who had been bitten by a stray mosquito arriving on board an aircraft.

Mosquitoes able to carry malaria have always existed in Britain, and the disease was endemic between the 16th and 19th centuries. David Rogers, a professor at Oxford University, said malaria was the disease referred to as ague by Shakespeare. It had died out in the 19th century because of better housing (partly because man stopped living close to farm animals), and draining of marshes.

The last outbreak in England was in Kent when troops returning from the first world war with malaria were bitten by local mosquitoes that spread the disease to people who had never left England.

A similar return from abroad of humans with malaria was how the disease was expected to be reintroduced, and it could occur at any time during the warm summer months.

Salt water marshes were most likely to breed malaria mosquitoes. The Norfolk fens, the Thames estuary, parts of south-east Kent, and the Somerset levels, where the disease thrived in the last century, were the most susceptible.

Prof Rogers said there was a danger of the second more deadly form of malaria reaching Britain.

Plasmodium falciparum killed 1m children a year in Africa. It was spreading to western Turkey and Mexico and could well be brought to Britain by holidaymakers.

Other "tropical" diseases like West Nile fever, which has recently killed people in New York, must also be candidates for reaching Britain. It was carried by wild birds and had already infected horses in southern France - showing it could spread to the UK, Prof Donaldson said.

Deaths from breast cancer among older women should show a 20% fall by 2004, according to a new study.

The reduction follows the introduction of the NHS screening programme more than a decade ago.

Cancer charities said the research was the first to show that the screening programme could save thousands of lives.

But the expected fall is not as great as the 25% target set for 2000 when screening was introduced, the research published in the British Journal of Cancer found.

Among women under 55, the screening programme will have reduced death rates by about 7% in three years' time.

Since 1988, women aged between 50 and 64 in the UK have been offered screening for the disease every three years on the NHS. The programme is now being extended to women up to the age of 70, with screening on request for those older than 70.

About 35,000 women develop breast cancer every year in Britain and more than 13,000 die from the disease.

Some experts have claimed that the screening programme does not save enough lives to justify its cost while concerns have also been expressed that the programme serves only to increase women's fears about developing breast cancer.

The latest study, which was funded by the Cancer Research Campaign and the Imperial Cancer Research Fund, compared the predicted outcomes of women diagnosed with breast cancer before they were invited for screening and those diagnosed after the programme was up and running.

The researchers said that improvements in the screening programme should mean that the target of a 25% fall may still be met, if a little late.

10 Feb 01 - Medicine - Aspirin can cut pregnancy risks, says report

A new report says aspirin taken in low doses can reduce a pregnant woman's risk of having a stillbirth or developing the potentially-fatal condition pre-eclampsia.

Low doses of aspirin can also reduce the chances of premature birth, a study in the British Medical Journal found.

Researchers from the Institute of Health Sciences in Oxford reviewed more than 30 previous studies of more than 30,000 women to assess the benefits of anti-platelet drugs, of which low-dose aspirin is the most common.

They found that women who had taken anti-platelet drugs had a 15% reduced risk of pre-eclampsia, an 8% reduction in premature birth and 14% less chance of their baby dying in the womb.

Pre-eclampsia affects 2%-8% of pregnancies and accounts for up to 15% of all deaths of women during childbirth.

The condition is a combination of high blood pressure and the build up of protein in the urine. If diagnosed early, it can be eased by bed rest and blood pressure drugs.

But in some cases, pre-eclampsia can become severe, leading to the death of both mother and child.

Experts do not know what causes the condition, although it is believed it may be linked to over-production of thromboxane, a substance produced in the body's platelets, which play an important part in ensuring blood clotting.

Anti-platelet drugs such as aspirin are often used to help thin the blood in patients with high blood pressure, and the researchers suggest that they can play a similar role in preventing pre-eclampsia.

Report author Lelia Duley said: "Data from this review should be made available to pregnant women as well as clinicians and policy makers. As the reductions in risk are relatively moderate, relatively large numbers of women will need to be treated to prevent a single adverse outcome. "

09 Feb 01 - Medicine - Genome makes customised therapies a reality

The vision of the future outlined yesterday by Francis Collins, one of the leaders of the world project to sequence the human genome, is by far the most authoritative prediction yet made of what humankind can expect from its knowledge of genetics.

Startling advances in medical science will be with us within ten years, with even more remarkable possibilities emerging by 2020 and 2030, he said. "If you're not dizzy yet about the effects of the genome, you will be in ten years," he told the Biovision biotechnology conference, which opened in Lyons yesterday.

By 2010:

Scientists will have developed accurate predictive tests for at least a dozen common diseases in which a person's genes may play a part, such as diabetes and heart disease, Dr Collins predicted. Because of these tests, GPs will be able to advise those patients who are at increased risk of preventative steps that they may take to avoid ill-health later in life. A patient diagnosed as at greater genetic risk of heart disease, for example, could be prescribed more exercise and a low-cholesterol diet.

"We will have uncovered the hereditary contribution to the bulk of the most common diseases in our society, with predictive tests for perhaps a dozen diseases, and interventions to reduce risk," he said.

IVF clinics will be making wide use of a complex technique known as pre-implantation genetic diagnosis (PGD) to screen embryos for genetic disorders, but fierce debate is likely to be raging over the ethics of its use. PGD has already been used to test embryos for disorders such as haemophilia and muscular dystrophy, but it is now likely to be developed to screen for many other illnesses.

The technique has already raised controversy about "designer babies". Last year, American scientists used it to create Adam Nash, the baby selected to be a precise tissue match for his sister, Molly, who needed a lifesaving stem cell transplant. Some doctors have sought to use it to screen embryos for sex, as with the Masterton family, who wanted to ensure they had a female baby.

Dr Collins believes that such ethical debates will become more common, as scientists learn to screen for more traits. Legislation to deal with "genetic discrimination" such as improper demands for test results by employers and insurers, should be in place, he said.

Medicine will be making use of "gene therapy" - by which abnormal genes in living patients are corrected using a genetically-modified virus - to cure conditions such as severe combined immune deficiency sydrome, an immune system disorder. Trials of such therapies have begun, but there are wide concerns about the technique's safety: one patient on a US trial died after suffering a severe immune response to the virus.

By 2020:

Doctors will be armed with gene-based designer drugs to treat almost every disease, Dr Collins said. Knowledge of the genetic factors at work in conditions such as diabetes, hypertension, heart disease and schizophrenia will allow the development of more sophisticated drugs that deal with the roots of the disorders.

Cancer treatment will be transformed. As tumours form when damage to DNA causes healthy cells to become abnormal and to divide unchecked, each has its own "molecular fingerprint". Scientists will be able to "read" this signature, and select the most appropriate treatment strategy as a result, Dr Collins said.

Similar developments in general medicine will mean that GPs will rarely prescribe any drugs without first performing a test to determine a patient's genetic make-up, to choose the therapy that will work best. Doctors will be able to determine which patients may suffer from adverse side-effects from particular drugs.

Treatments for mental illness will be transformed, with researchers understanding the biological basis for schizophrenia, depression and autism, and having access to new drugs. As a result, the stigma attached to such conditions may be removed.

"Mental illness may be one of the major beneficiaries of this effort as well," he said. "We are certainly close to understanding hereditary contributions to manic depressive illness, to schizophrenia, to obsessive-compulsive disorder, to autism, in a way that should leave us, at least, to a better biological understanding of these vexing problems and perhaps an opportunity to stop blaming the victims and treat them as victims of a disease that deserve compassion and better opportunities for therapy."

Most controversially, Dr Collins suggested that "germline" gene therapy - by which doctors change the genetic make-up of a living person, who will pass on any acquired genes to his or her offspring - could be both possible and safe.

This technique, which would probably use a virus as a "vector" to carry new DNA into the body's cells, including eggs and sperm, could be used to allow people who carry a recessive genetic disorder such as Huntington's disease or Duchenne muscular dystrophy, to "cleanse" their DNA of the potential to pass the condition to their children.

"If we were successful in another 20 years at learning how to go in and very surgically change a single base pair of genes in the genome into something that was not going to cause disease, then it would be tempting to begin to contemplate this in a more serious way," Dr Collins said. "Perhaps in another 20 years we will have that capability."

By 2030:

Healthcare based on the study of genetics will have become the norm, Dr Collins said. As a matter of routine, every patient will take genetic tests to be used to draw up an individual programme of preventive medicine to reduce the risks posed by his or her genome. Wide knowledge of genes will enable medical science to narrow down the environmental factors that cause disease, with great potential for improving public health.

"In 2030, if all goes well, there should be the kind of comprehensive genomics-based healthcare, where we have individualised preventive medicine based on your individualised risk instead of a 'one size fits all' approach."

Understanding of human cells and tissue will have become so advanced that most medical research will be carried out on computer models, rather than on living tissue in culture, or on animals. "Many investigators will find that only occasionally do they have to pick up a pipette and do an experiment in a test tube."

He said: "If all goes well, at least in the developed world, perhaps the average lifespan will extend to something like 90 years which will put great stresses on our social and economic systems."

Genetic advances will also have negative consequences by this stage, Dr Collins said. In particular, a major "anti-technology movement" will gather widespread public support worldwide, he expects.

This will follow humanity's realisation that genetic knowledge will place humankind's genetic destiny in its own hands: we will have the ability to manipulate the future evolution of the species, and there will be fierce debate about whether we should make use of our skills.

He said: "I wouldn't be surprised if in another 30 years that some people will begin to argue that we ought to take charge of our own evolution and should not be satisfied with our current biological status and should as a species try to improve ourselves.

"I find this an interesting but somewhat chilling discussion. I think from my own perspective that is an enterprise I would hope we will not undertake for a long time, if ever."

09 Feb 01 - Medicine - Folic acid can help boost sperm count

Taking extra amounts of the vitamin folic acid in the diet can boost the quality and quantity of sperm in men who suffer partial infertility, says a leading toxicologist.

Professor Bruce Ames of the University of California told the World Life Science Forum in Lyon yesterday that research yet to be published demonstrates the importance of folic acid in the diet for high sperm counts in men.

Folic acid is a recommended food supplement for pregnant women as a precaution against the risk of certain birth defects but this is the first time it has been shown to have a potentially beneficial effect on male fertility.

Professor Ames said suggestions that so called "gender bender" chemicals in the environment are responsible for the significant fall in sperm counts does not fit in with the fact that there are many natural chemicals in plants which mimic female hormones and which could themselves lower sperm counts.

"It just isn't credible," said the professor. "It does not make sense when you look at the whole picture. We have more important things to worry about, we have to get ourselves on a good diet and stop smoking. Rat studies show that if you don't take your folic acid, the sperm count goes down by 90 per cent. We have shown this in people too."

Folic acid appears to be able to prevent breaks in the chromosomes which may explain its sperm-boosting effects, he suggested.